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Voiding cystourethrography in children: value of digital fluoroscopy in reducing radiation dose
R H Cleveland1, C Constantinou, J G Blickman
1Department of Radiology, Massachusetts General Hospital, Boston 02114.
Insights
A new digital fluoroscope significantly reduces radiation dose during voiding cystourethrography in children. This advancement lowers skin and ovarian radiation exposure compared to traditional methods, enhancing patient safety.
Area of Science:
- Medical Imaging
- Pediatric Radiology
- Radiation Dose Reduction
Background:
- Voiding cystourethrography (VCUG) is a common fluoroscopic procedure in children.
- VCUG can directly irradiate the gonads, necessitating radiation dose reduction strategies.
Purpose of the Study:
- To evaluate a digital fluoroscope adapted for pediatric use for its potential to reduce radiation dose during VCUG.
- To compare radiation doses from digital spot films versus conventional 105-mm spot films in pediatric VCUG.
Main Methods:
- Radiation doses (entrance, midplane, skin, ovarian) were calculated using child-sized phantoms and subsequently in 47 children across different age groups.
- A newly adapted digital fluoroscope was compared with conventional 105-mm spot films and radionuclide VCUG for dose and image quality.
Main Results:
- Digital spot films reduced radiation dose by approximately 50% compared to 105-mm spot films in children under 5 years old.
- Image quality from digital spot films was comparable to 105-mm spot films for clinical decision-making.
- Ovarian dose with digital spot films was 0.62 mGy greater than radionuclide VCUG but significantly lower than conventional fluoroscopic methods.
Conclusions:
- The evaluated digital fluoroscope effectively reduces radiation dose during pediatric voiding cystourethrography.
- Digital fluoroscopy offers a safer alternative to conventional methods, providing adequate image quality with lower radiation exposure.
- Further optimization may be needed to match the extremely low doses of radionuclide cystography.
Abstract:
Voiding cystourethrography is a commonly used fluoroscopic procedure in children that can directly irradiate the gonads. As a consequence, much attention has been given to reducing the dose of radiation received during the procedure. A digital fluoroscope, especially adapted for use in children, was evaluated for potential reduction of the dose of radiation during the procedure. Entrance and midplane doses were calculated on child-sized phantoms by using the digital fluoroscope, digital spot films, and 105-mm spot films. Subsequently, data were collected on 47 children, grouped by ages (neonate to 1 year, 1-5 years, and 5-7 years), in whom voiding cystourethrography was performed by using the same exposure factors as those for the phantoms. On the basis of the exposure doses for the phantoms and recorded clinical peak kilovoltages, milliamperes, milliseconds, and fluoroscopic time, average skin and ovarian doses were calculated for each group of children. These doses were compared with previously reported doses for fluoroscopic and radionuclide voiding cystourethrography. Results of line-pair resolution studies for the digital spot films and 105-mm spot films were similar. Images from the digital device and 105-mm images obtained on a conventional fluoroscope were considered equally adequate for clinical decision making. The average midplane and skin doses with digital spot films for children less than 5 years old were equal to or less than 0.66 and 2.37 mGy, respectively, as opposed to 1.37 and 5.32 mGy with the 105-mm spot films. Previously reported ovarian doses range from 2.52 to 10.0 mGy for fluoroscopic voiding cystourethrography and from 0.04 to 0.05 mGy for radionuclide voiding cystourethrography. The use of digital spot films reduced dose approximately 50% compared with 105-mm spot films; the ovarian dose was 0.62 mGy greater than that for radionuclide voiding cystourethrography.